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Background and Objectives Apathy is a common symptom in dementia and is associated with rapid cognitive decline, poor quality of life, and higher mortality. Lawton’s Competence and Environmental Press model suggests that an individual’s behavior and affect are influenced by the fit of their functional abilities with the environmental demands. Yet, empirical evidence on the association between person–environment (P–E) fit and apathy is lacking. Thus, this study examined the relationship between P–E fit and apathy in dementia. Specifically, this study focused on the extent the physical environment fits individual functional limitations. Research Design and Methods This is a cross-sectional study using the baseline data from long-term care residents with dementia. The sample included 199 residents with moderate-to-severe cognitive impairment from 4 assisted living and 4 nursing homes. Function-focused P–E fit was measured using the Housing Enabler scale. Apathy was measured using the Apathy Evaluation Scale. Multilevel linear models were used to analyze the relationship between P–E fit and apathy. Results Findings revealed that greater P–E fit, specifically indoor environment, was significantly associated with lower apathy after controlling for age, gender, and years living in the facility. Yet, the association became not significant after controlling for individual physical function. Discussion and Implications Findings support the association between function-focused P–E fit and apathy, but the association is no longer significant after physical function is adjusted. Future research may explore other aspects of P–E fit and the impact of social and organizational environment on apathy in dementia.

Purpose of the Study: The purpose of this study was to test the impact of Function-Focused Care for the Cognitively Impaired Intervention on nursing home residents with dementia and the nursing assistants who care for them. Design and Methods: This was a cluster-randomized controlled trial using repeated measures. A total of 103 cognitively impaired residents and 77 nursing assistants were recruited from four nursing homes. For residents, outcome measures included function, physical activity (survey and actigraphy), mood, behavior, and adverse events (falls and hospitalization). Main outcome measures for nursing assistants included knowledge, beliefs, and performance of function focused care. Results: There were significant improvements in the amount and intensity of physical activity (by survey and actigraphy) and physical function in the treatment group. In addition, there was a significant decrease in the number of residents who fell during the treatment period with those in the treatment sites having fewer falls (28% vs. 50% in the control group). Nursing assistants were also observed to be providing a greater percentage of function focused care during resident care interactions in the treatment group at 6 months following the completion of baseline measures. Implications: This study provides some evidence that nursing home residents with severe cognitive impairment can safely and successfully be engaged in physical and functional activities.

Objective: The purpose of this study was to test reliability and validity of the Physical Resilience Scale. Methods: A single-group repeated measure design was used and 130 older adults from three different housing sites participated. Participants completed the Physical Resilience Scale, Hardy–Gill Resilience Scale, 14-item Resilience Scale, 5-item Geriatric Depression Scale, and the Yale Physical Activity Survey at baseline and again 2 weeks later. Results: There was evidence of validity of the Physical Resilience Scale based on model testing using a Rasch Analysis and significant correlations with commonly used general resilience measures. Evidence of reliability was supported based on a Separation Index and alpha coefficient of .89 and test–retest reliability with correlations between testing times of .73. Discussion: Future use of the Physical Resilience Scale should consider adding more challenging items to better differentiate those particularly high in physical resilience.

Purpose: T he purpose of this study was to test the effectiveness of a 12-month restorative care (ResCare) intervention on the beliefs related to Res-Care, knowledge of Res-Care, observed performance of Res-Care with residents, and job satisfaction among nursing assistants (NAs) in nursing home (NH) settings. Design and Methods: This was a randomized controlled trial including 12 sites and used a repeated measure design with follow-up testing done at 4 and 12 months. An intention-to-treat principle was followed in all analyses, and generalized estimating equations were used to perform repeated measures. A total of 556 NAs consented to participate and completed baseline assessments (265 in treatment and 258 in control sites), 427 completed 4-month follow-up (218 in treatment and 195 in control sites), and 357 completed 12-month follow-up (168 in treatment and 158 in control sites). Results: There was a statistically signifi cant increase in the treatment group participants ’ outcome expectations related to Res-Care activities ( p = .04) and performance of Res-Care ( p < .001) at 4 months, and an increase in knowledge of Res-Care ( p < .001) and job satisfaction ( p < .001) at 12 months. There was no difference between the groups with regard to self-effi cacy expectations. Implication: This study provides an important step in understanding the implementation of a Res-Care philosophy in NH settings and the benefi t this can have for NAs.

Purpose: The purpose of this report is to evaluate the reliability and validity of the five-item Evaluation to Sign Consent (ESC), a measure that can guide determination of an older adult’s capacity to consent for research. Design and Methods: Information was obtained from 346 nursing home residents from six facilities who were being enrolled into a randomized controlled trial testing a restorative care intervention. In addition to the ESC, the resident’s cognitive status and demographic information was obtained. Results: The average age of the participants was 86.1 6 7.3 years; most of the participants were female (84%) and Caucasian (95%). The mean Mini-Mental State Exam score was 18.0 6 7.4. A total of 218 residents (63%) did not pass the ESC. According to a Rasch analysis and the inter-rater reliability (r = .81), there was some evidence of reliability and validity with this measure. Logistic regression showed that Items 1 (describing two risks to participation in the study) and 2 (knowing what is associated with participation) had the greatest overall percentage of agreement with the full ESC, and the Mini-Mental State Exam was the only resident-tested variable to predict the results of the ESC. Implications: This study provides useful information about the ESC. It indicates a reason and a method to move beyond cognitive testing that can more appropriately evaluate the capacity to consent to participate in research.

Purpose of the study Assisted living (AL) residents with dementia require assistance with activities of daily living, encounter limited opportunities to engage in physical activity, and often exhibit challenging behavioral symptoms. The Function Focused Care Intervention for the Cognitively Impaired (FFC-CI) teaches and motivates direct care workers (DCWs) to engage residents with dementia in activities that optimize function and activity while minimizing behavioral symptoms. The purpose of this study was to test the impact of FFC-CI on function, physical activity, behavior, and falls. Design and methods A cluster-randomized trial included 96 residents with dementia and 76 DCWs from 4 ALs. Generalized estimating equations were used to evaluate outcomes at 3 and 6 months. Results There were no treatment by time differences with regard to resident behavior, mood, counts of physical activity based on actigraphy, falls, and function. There were significant increases in physical activity based on kilocalories burned (p = .001), time spent in physical activity based on survey results (p = .001), and time spent in repetitive behaviors, such as wandering (p = .01) among the control group over time. There were no treatment by time differences with regard to DCW beliefs, knowledge, or performance of FFC, except for less decline in job satisfaction among the treatment group (p = .002). Treatment fidelity with regard to delivery and receipt were poor due to high staff attrition in the treatment group (46% vs. 16%) and limited site support. Implications The findings from this study can be used to adapt future FFC intervention studies to improve treatment fidelity and optimize intervention efficacy.